Frequently Asked Questions

How do I become a Vaccine for Children (VFC) provider?

If my FQHC or RHC takes over a Parish Health Unit do I automatically become a VFC provider?

No. You are considered new and must be enrolled in the VFC program first.

Can I inherit vaccine from a Parish Health Unit automatically and move to my new location?

No. Participation in the Vaccines for Children Program is not automatic. Vaccines at the closed Parish Health Unit must be accounted for with the VFC Program/Immunization Program Office. Vaccine movement and logistics need to be coordinated with our VFC Program/Immunization Program to assure that vaccines are not compromised and are adequately accounted for.

What is the target population that can be immunized with the VFC Program/Immunization Program issued vaccines in public clinics such as Parish Health Units, Federal Qualified Health Centers (FQHC) and Rural Health Centers (RHC)?

The VFC Program/Immunization Program issued vaccines allows the vaccination of Medicaid enrollees, un-Insured, American Indians/Alaskan Natives and “under-insured” individuals from birth through 18 years of age.

If a patient meeting age limits has private insurance and our public clinic can bill insurance (third party billing) can he/she be vaccinated with vaccine issued by the VFC Program/Immunization Program?

No. Not if it is known that the individual has insurance coverage. An insured individual does not qualify for publicly purchased vaccine under the law governing the VFC Program/Immunization Program, regardless of vaccine coverage/non-coverage, co-pays, and deductibles. Privately purchased vaccine MUST be purchased and administered.

We understand that the VFC Program/Immunization Program issue vaccines from birth through age 18 years, but what about those persons who are over nineteen years of age?

During the influenza season the VFC Program/Immunization Program distributes influenza doses limited to age/vaccine appropriate individuals through 18 year of ages. In addition, it also provides state purchased influenza vaccine to immunize high risk adults. The program primarily distributes the influenza vaccines to nursing homes and local health departments. There is insufficient funding to provide influenza vaccine to other medical providers or adult age groups.

Can Tdap/Td be provided to persons 19 years of age and older using VFC Program/Immunization Program?

No. Current Federal and State budgets are inadequate to provide these vaccines to adults 19 years of age and older. This is also applicable to any other age appropriate vaccine to persons 19 years of age and older.

Can we vaccinate “first responders” not meeting age eligibility using VFC Program/Immunization Program vaccine?

No. Current Federal and State budgets are inadequate to provide these vaccines to adults 19 years of age and older. This is also applicable to any other age appropriate vaccine to persons 19 years of age and older.

Is Medicaid federally mandated to cover ACIP’s VFC-recommended vaccines for the Medicaid population?

Yes, all of ACIP’s VFC-recommended vaccines are part of the EPSDT benefit package for Medicaid children under age 21. Immunizations through age 18 years are covered by the VFC program. Children 19 years through 20 years are covered by Medicaid program funds at their private medical providers.

Can a state require Medicaid providers to become VFC-program registered providers in order to ensure that Medicaid-eligible children receive vaccine under the VFC program?

Yes, the state Medicaid agency does have the option to require participation in the VFC Program.

What are the statutory requirements for the VFC program regarding the vaccine administration fee?

Section 1928(c) (2) (C) (ii) of the Social Security Act (42 U.S.C. 1396s(c) (2) (C) (ii)) states: "The provider may impose a fee for the administration of a qualified pediatric vaccine so long as the fee in the case of a federally vaccine-eligible child does not exceed the costs of such administration (as determined by the Secretary based on actual regional costs for such administration)." Section 1928(c) (2) (C) (iii) of the Social Security Act (42 U.S.C. 1396s(c) (2) (C) (iii)) further provides that: "The provider will not deny administration of a qualified pediatric vaccine to a vaccine-eligible child due to the inability of the child's parent to pay an administration fee." The Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), published a notice of the federal regional administration fee caps in the Federal Register on October 3, 1994 (59 FR 50235). The notice also indicated that state Medicaid programs could establish lower administration fees for VFC vaccination of Medicaid children. Except in the case of an inability to pay, the notice further stated that VFC providers can charge non-Medicaid federally vaccine-eligible children (i.e., uninsured, American Indian/Alaska Natives, and when administered by an FQHC or RHC, underinsured children) up to but not more than the maximum regional administration charge (if that charge reflects the provider's cost of administration) regardless of whether the state has established a lower administration fee under the Medicaid program. The administration fee caps do not apply to vaccination of state vaccine-eligible children. The VFC program does not have any authority over administration fees charged to state vaccine-eligible children or privately insured children. For example: State A’s Medicaid Agency has set the state Medicaid vaccine administration reimbursement at $10.00. The state’s regional administration fee cap is $15.00. A VFC-enrolled provider can expect to receive $10.00 for the administration of a vaccine to a VFC-eligible child enrolled in Medicaid. The VFC-enrolled provider can charge a maximum of $15.00 to a VFC-eligible child NOT enrolled in Medicaid. The VFC program does not regulate administration fees charged to private pay or privately insured patients.

Who should pay the vaccine administration fee for Medicaid-eligible children?

The state Medicaid agency should be billed for the administration fee for Medicaid-eligible VFC children immunized by a Medicaid-enrolled VFC provider. State Medicaid agencies establish their own policies and administration fees that may be lower than the regional maximum charges established in 1994. For Medicaid VFC-eligible children, the state Medicaid agency determines and CMS approves the reimbursable amount for their fee-for-service and managed care enrolled recipients. If the provider bills Medicaid the regional maximum charge instead of the Medicaid agency’s allowable rate the provider will be reimbursed only the allowable rate and not the amount billed. The difference between the allowable rate and the amount billed cannot be collected from the parents of the child.